Nutritional Challenges in Chronic Kidney Disease

#1 - Nutritional Assessment in CKD

I. Assessment steps

A. Medical history
B. Diet history
C. Pertinent biochemical data

II. Anthropometric measures

A. Determining body weight
B. How to calculate adjusted body weight
C. Adjustment for amputees
D. Frame size
E. BMI

III. Subjective global assessment

A. Weight history/current patient status
B. Physical assessment
C. Functional status

IV. Socio-economic factors affecting nutrition in CKD

A. Home environment
B. Mobility
C. Scarcity of resources

Behavioral/Learning Objectives:

1. Identify three assessment steps.
2. Explain how to calculate adjusted body weight.
3. List global assessment data.
4. Identify socio-economic factors that can affect the nutritional status of the CKD patient.
   

#2 - Medical Nutrition Therapy as Determined by Dialysis Modality

I. Medical nutrition therapy for the pre-dialysis patient

A. Nutrient recommendations per stages of CKD

• Protein
• Calories
• Potassium
• Phosphorus
• Sodium
• Calcium
• Fluid

II. Medical nutrition therapy for the hemodialysis patient

A. Nutrient recommendations

• Protein
• Calories
• Potassium
• Phosphorus
• Sodium
• Calcium
• Fluid

B. National renal diet

• Food Choice list
• Designing a meal plan

III. Medical nutrition therapy for the peritoneal dialysis patient

A. Nutrient recommendations

• Protein
• Calories
• Potassium
• Phosphorus
• Sodium
• Calcium
• Fluid

B. Estimating calories absorbed from dialysate

IV. Medical nutrition therapy for the transplant patient

A. Immunosuppressants
B. Nutrient recommendations

• Protein
• Calories
• Potassium
• Phosphorus
• Sodium
• Calcium
• Fluid

V. Case study on utilizing the National Renal Diet

Behavioral/Learning Objectives:

1. List the nutrient recommendations for all stages of CKD
2. Identify the nutrient recommendations for the hemodialysis patient.
3. Identify the nutrient recommendations for the peritoneal dialysis patient
4. List the nutrient recommendations for the transplant patient.
   

#3 - Heart Disease and CKD

I. Prevalence of Heart Disease in CKD

A. Most current USRDS data

II. Causes of heart disease in CKD

A. Hypertension
B. Smoking
C. Diabetes control
D. Obesity

III. Definition of dysplipidemia according to the Adult Treatment Panel III Guidelines
IV. Guidelines for the treatment of dyslipidemia per KDOQI

A. Guidelines 1 through 5.

V. Therapeutic lifestyle changes (TLC) in patients with CKD

A. Diet
B. Exercise
C. Lifestyle habits
D. Supplements that that may have an effect on heart disease

• Fiber
• Fish oils
• Soy
• Plant sterols

Behavioral/Learning Objectives:

1. Describe the prevalence of heart disease in CKD patients.
2. Identify the causes of heart disease in CKD patients.
3. List the guidelines for the treatment of dyslipidemia per KDOQI.
4. List 3 therapeutic lifestyle changes in patients with CKD.

#4 - Renal Bone Metabolism

I. Prevalence of bone disease/mineral disregulation in CKD
II. Causes of bone disease in the CKD patient

A. Phosphorus retention
B. Vitamin D deficiency
C. Secondary hyperparathyroidism

III. Types of bone disease in the CKD patient

A. Hyperparathyroidism
B. Osteomalacia
C. Adynamic bone disease
D. Mixed osteodystrophy

IV. Guidelines of bone metabolism in CKD

A. Goals for PTH
B. Goals for calcium X phosphorus
C. Goals for calcium
D. Goals for phosphorus

V. Medications used in the treatment of bone metabolism disregulation

A. Binders

• Calcium based
• Sevelamer Hydrochloride
• Sevelamer Carbonate
• Lanthanum Carbonate

B. Vitamin D

• Calcitriol
• Zemplar
• Hectorol

C. Calcimimetics

• Sensipar

VI. Case studies on bone metabolism management in CKD.

Behavioral/Learning Objectives:

1. Describe the prevalence of bone disease/mineral disregulation in CKD.
2. List the causes and types of bone disease.
3. Identify the guidelines of bone metabolism in CKD.
4. Identify medications used in the treatment of bone metabolism disregulation.

#5 - Anemia In CKD

I. Prevalence of anemia in CKD and etiology

A. Terminology of anemia
B. Types of anemia
C. Laboratory values used to diagnose anemia
D. Symptoms of anemia

II. 2. The roles of Epogen/Aranesp

A. Possible adverse effects
B. Causes of Epogen/Aranesp resistance

III. Role of transfusion
IV. Guidelines for the management of anemia in CKD

A. Anemia protocols
B. Target ranges for hemoglobin

V. Iron

A. Laboratory tests used to diagnose iron deficiency
B. Estimation of iron needs
C. Recommendations for IV iron
D. Recommendations for oral iron
E. Medications that may interfere with iron absorption.

VI. Case studies on anemia management

Behavioral/Learning Objectives:

1. Describe the prevalence and etiology of anemia in CKD.
2. Explain the roles of Epogen/Aranesp/iron.
3. List the guidelines for management of anemia in CKD.

#6 - Malnutrition in CKD

I. The prevalence of malnutrition in the CKD population
II. Review the etiology

A. Malnutrition/inflammation syndrome

III. Strategies to prevent or treat malnutrition in the CKD patient

A. Oral supplementation
B. Enteral/parenteral
C. Intra-dialytic parenteral nutrition

IV. Utilization of the nutrition care process to diagnose and treat malnutrition

A. Nutrition assessment and reassessment
B. Nutrition diagnosis
C. Nutrition Intervention
D. Nutrition monitoring and evaluation

V. Case study examples using the nutrition care process

Behavioral/Learning Objectives:

1. Describe the prevalence of malnutrition in the CKD population.
2. Explain the etiology of malnutrition/inflammation syndrome.
3. List strategies to prevent and/or treat malnutrition in the CKD patient.
4. Explain how to use the nutrition care process to diagnose and treat malnutrition.

Accreditation Information

Dietitians - Academy Medical Systems is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 9.0 continuing professional education units (CPEUs) for completion of this program/material.

Nurses – Academy Medical Systems is an approved provider of continuing nursing education by the Illinois Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. 9.0 contact hours will be rewarded to nursing professionals at the completion of this workshop.

Academy medical Systems is also a provider approved by the California Board of Registered Nursing, provider #CEP14413, for 9.0 hours. And we are also a provider approved by the Florida Board of Nursing, provider #50-19, for 9.0 hours.

Iowa Nurses – The Iowa Board of Nurses will recognize the recorded webinars as a home study program. They recognize our ANCC approved provider status as well as our CA and Fl Board of Nursing provider approval for home study products for nurses in Iowa.

All other states recognize our approved provider status listed in the above text for continuing education credit for nurses.
Nephrology Technicians – The BONENT, NNCC, and NNCO recognizes our approved provider status with the American Nurses Credentialing Center (ANCC) for continuing education requirements for certification and recertification purposes.

Occupational Therapist - Occupational Therapist will receive 9, continuing education hours for completion this program and a test score of 70% or better. AMS is an approved provider for the AOTA , provider # 5470.

Exercise Physiologist – ACSM recognizes AMS’s approved provider status with the ANCC and will honor our continuing education for Certified Exercise Physiologist recertification purposes.

Certified Athletic Trainers – Academy Medical Systems is recognized by the Board of Certification (BOC) to offer continuing education for certified athletic trainers. 9 hours will be awarded at the completion of this program.

Physical Therapists - PTs in the following states will receive 9 contact hours for completion of all 6 webinars: AK, CO, CT, HI, IA, ID, IN, KS (Cat 2), MA, ME, MI, MN (Cat 2), MT, NE, NM, ND, OR, PA, RI, SC, SD, UT, VA (Type 2), VT, VI, WA, WY.

We are an approved provider to offer continuing competency courses to CA PTs, approval date 4/5/10.

The following state boards recognize other state’s approval: AL, AZ, GA (Class 1), KY, MO, MS, OK (Cat 2), TN (Cat 1), WI.

Because each state’s continuing education requirements for physical therapists is subject to change, please verify this information with your state board. Thank you.

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